Intrauterine System Migration: Case Report and Decision Making

Background: The intrauterine system (IUS) is a hormonal contraceptive device manually inserted inside the uterus. IUS-related uterine perforation is rare but this complication is potentially severe. A case of IUS migration in a woman previously operated on for uterine perforation is presented. Options and choices of the treatment are analyzed. Case: A 36-year-old woman presented with a uterine perforation as a consequence of a migrated IUS. The patient was completely asymptomatic, and no clinical history was provided for this patient. A pelvic computed tomography scan showed that the device lay almost completely inside the myometrium except for one of its arms, which appeared on the serous layer of the uterus. Considering a possible further displacement of the coil and the consequent risk of adhesions and fistulae formation, a laparotomy was performed to retrieve the foreign body. Results: The patient was discharged from the hospital successfully, with no complications. Conclusions: In cases of uterine perforation associated with intrauterine devices, different clinical and surgical aspects have to be considered to make the correct treatment decision. In this case, the possibility of further extrauterine displacement and the feared risk of bleeding from previous uterine surgery led to a decision to remove the coil by laparotomy. Controversies still exist regarding the appropriate treatment in these cases. ( J GYNECOL SURG 28:61)